I recently discovered that two friends of mine suffer from trichotillomania, or compulsive hairpulling. It came as a surprise to me, and even as a clinical psychologist, it was difficult to detect because neither one of them pulls out their hair in an obvious manner. Although about 3 percent of the U.S. population experiences trichotillomania during their lifetime, few people know what it is — and even fewer want to talk about it, which adds to the elusiveness of this disorder.

Trichotillomania (pronounced trick-uh-till-uh-may-nia), often called trich, is characterized by an uncontrollable urge to pull out one’s hair — from the scalp, eyebrows, eyelashes, or other areas of the body — to neutralize an anxious feeling. If the hairpulling is severe enough, it can leave bald patches, which my clients often describe as embarrassing, isolating, and frustrating.

Hairpulling can take place unconsciously or consciously due to boredom, stress, anticipatory anxiety, zoning out, and other circumstances. After pulling out hair, my clients may even report feeling relief or satisfaction as they describe having “scratched an itch” or “pulled out a hair that didn’t belong.” Family and friends can find it perplexing that a loved one could find this habit pleasurable. Indeed, it could be a sign the person may be dealing with unresolved anxiety or an inability to cope with stress in a productive way. But sometimes no defined reason can explain the behavior.

If you or someone you know suffers from trich, the best bet is to find a licensed psychologist who is trained in cognitive-behavioral therapy (CBT) and habit reversal training to help manage symptoms. In the meantime, I’ve compiled a list of questions NOT to ask the person suffering from trich because these can often do more damage than good.

What Not to Do

1.  Don’t ask, “Why don’t you just stop?”

Chances are, the person already asks themselves this question every day. This diagnosis can carry a lot of shame, and this statement assumes it is easy to stop pulling. If someone could stop, they would.

2.  Don’t suggest, “Stop covering your bald spots so you can actually see the damage.”

Covering up is controversial. While some clients find it freeing to take off their makeup and wigs, others find it shameful and embarrassing, and they can regress to feeling hopeless, helpless, and far from their goals of stopping the behavior. Until you know how someone will react to this strategy, skip this advice.

3.  Don’t say, “You need to learn to relax, and maybe the pulling will stop automatically.”

Usually, this isn’t true. My clients with trich have hairpulling on their mind constantly (which can be mentally exhausting) and have uncontrollable urges to pull. These urges typically require much more than just relaxation to reverse themselves, so don’t assume it’s that easy.

4.  Don’t carefully observe the person and signal or say something when they are pulling...

…unless the person asks you to do this. Many people feel watched and judged with this technique, so ask them if verbal notice would help before becoming the “pulling police.”

Other resources:

What Is… Trichotillomania? Causes, Treatments, and Resources